STUDENT CONTRIBUTOR: Liza Khalyavka | School of Nutrition, Ryerson University
October 25, 2020
Diversity has been an important topic of much conversation and debate over the past few months. What's the first thing that comes to mind when you hear the word diversity?
If you're like most people, a variety of things probably come to mind; different cultures and ethnic backgrounds, maybe a variety of food or even different sexual orientations. The definition of diversity is different for different people. The thing is, diversity is much more than just a word or a category, it is one of the most important, impactful, complex, necessary topics in today's society that is not talked about enough, and highly misunderstood. With that said, let's dive deeper into the role and representation of diversity in the field of dietetics.
So… what does diversity actually mean?
The Global Diversity Practice defines diversity as 'any dimension that can be used to differentiate groups and people from one another'. Essentially, diversity recognizes that every person has unique characteristics that makes them stand out in society, which can go beyond age or ethnicity. If you're still a little confused, have a look at the picture, above. After all, pictures speak louder than words!
A recently published journal detailing the results of an online semi-qualitative survey sent to Canadian dietitians spotlighting the positive attitudes towards the role dietitians can play and unique ways they can address existing social injustices and health inequalities, but are mostly somewhat unsure as to how advocacy in this arena fits within scope of practice. There was a unified concern that currently experienced barriers and limitations would only further complicate efforts to perform socially just practice. The data supports the critical influence that dietitians can have on the determinants of health and emphasizes a need for a socially just dietetic practice and advocacy framework from which current and future dietitians can incorporate within the various settings they practice and populations they support..
What's the importance of diversity in dietetics?
Diversity makes a positive impact on society by bringing different perspectives, unique opportunities and ideas influenced by practices and traditions from all over the world. The most consistent information available suggests that there is little representation of Black Canadians within our health system. Because of this imbalance, future Black dieticians may not want to enter a field where they are so under-represented but, for the same reason, they could make huge contributions. Registered dietitian Sharon Salomon describes that “to be effective nutrition counselors, we have to mirror the populations we serve in all aspects, because people are more comfortable being assisted by someone who is like them in terms of appearance and language”.
Ben Sit, a sports dietitian, takes us through his perspective on diversity in the dietetic field saying “If you Google image search “nutrition” you will primarily find pictures of white women eating salads. If you Google search “graduating class” images in nutrition programs across the country, you will find minimal diversity and any diversity that exists exhibits white-passing privilege”. Unfortunately, as Ben pointed out, diversity has not been a priority in the dietetic field.
Tamara Melton added that dietitians have a very narrow range of what healthy food looks like and often fail to consider food practices of other cultures, another consideration potentially discouraging people of different backgrounds from pursuing the field.
In the journal Strategies for addressing the Internship Shortage and Lack of Ethnic Diversity in Dietetics, the authors stated that only 2.5% and 1.7% of registered dietitians were African American and Hispanic. Another study done found white nutrition undergraduates being almost 4 times more likely to become dietitians, compared to non-white people. For many of us, these are surprisingly shocking stats, considering the growing global acceptance of multiculturalism. How can a field so saturated by one singular race and culture possibly give the best, most comprehensive nutrition care to a society that is known for its multiculturalism?”
Where are we, now? How to we address issues of racism, social justice and equality?
Very recently, organized efforts have begun to evolve dietetics toward a much more diversity-positive field within healthcare. In addition to dietetics being predominantly white, there is also some anti-black racism coming from health professionals.
There were many Black individuals who voiced their experiences of accessing the Canadian health system and experiencing racism. One of the main problems that Black people face is the one-size-fits all approach in health, as health professionals fail to recognize that not everyone has access to all the health-related services, and not all cultures and ethnicities eat using a plate model.
What does the future of dietetics hold?
Thankfully, things are moving in the right direction. There are many different organizations recognizing and prioritizing this issue, and collaborating to create interventions to address them. Jeanette Jordan, who’s a registered dietician, praises the American Dietetic Association's (ADA) effort to increase diversity; although she believes we've got a long ways to go. In general, the ADA does a decent job addressing equality and social justice by having its leaders and members organize working committees, by offering scholarships and grants to minority communities, and soliciting minority members' advice. The word “decent” is used, because - as with. many dietetic and nutrition-related organizations, colleges or associations - the ADA could do much more.
Diversify Dietetics, an organization founded in 2018 by dietitians Deanna Bellany and Tamara Melton, has a mission “to increase diversity in the field of nutrition by empowering students and young professionals from underrepresented minority groups to join the next generation of nutrition experts.”
Another intervention with potential to make great strides in an effort to diversify dietetics was taken up by The Matter of Black Health pilot project in 2017, who provided a blueprint for culturally specific programs aimed to support Black Nova Scotians. Those who participated worked alongside Black coaches who understood some of the barriers they faced in their regions. Of the 165 participants, 75% felt more confident navigating the health-care system. Hopefully, one day, with the evolving healthcare system, more participants will feel comfortable accessing services and feeling assured that they will receive the best service possible, no matter who they are or where they come from!
Finally, The Diversity Strategic Plan of 2015-2020 hopes to impact and change how educational centres give opportunities to students that have different cultural backgrounds. This effort includes increasing the diversity of future nutrition and dietetic RDs, as well as the cultural competence of current RDs. Following this plan, a mentor program was created called “Building out Future” which is used to assist current dieticians to recruit culturally diverse students.
What about people with diabetes?
Chronic conditions such as diabetes are seen quite often in minority groups and the racism coming from practitioners definitely does not make it easier to access healthcare services. Data suggests that Black adults are 6.6 times more likely to develop diabetes in their lifetime compared to white adults. Interpret this with the knowledge that there is a lack of race-based data collection, due to systemic racism, distrust of the health system and larger rates of poverty. Julie Wagner and other authors stated that racism indirectly increases one’s risk for diabetes as she gathered data from Black participants who stated that racism coming from health professionals creates stress on their mental and physical health, which makes it harder for them to manage their diabetes.
The Matter of Black Health pilot project tackled diabetes and hoped to help their participants improve self-management of blood sugars, in addition to other chronic disease management factors. What's interesting is that, after this program, participants' blood pressure and blood sugar levels were lowered! This is a promising result, because this project not only addressed racial issues, but also helped minority groups manage their diabetes better. The project has goals to be expanded beyond Nova Scotia to other regions in Canada.
Sharon Davis-Murdoch, Charisma Grace and Jalana Lewish state in their article that necessary policies, more research, training and programming are the steps required that will reduce the rates of diabetes among Black Canadians, as well as a competent Black leader being needed to take matters into their hands to help out their community.
Juliet Opoku, a registered nurse and a certified diabetic educator is a mentor and a leader who connects Black immigrants with no insurance to healthcare support services. She works with the Ghanaian Canadian Association of Ontario to build a community centre for people of all ages in the GTA. She wishes to develop inclusive programs where people are not judged by their race and ethnicity. Leaders like Juliet are the hero’s that make a difference in our communities, who help people manage their health and address the issues of racism in the healthcare field.
It is encouraging to see that there are many organizations getting people together to address such extremely important issues as social justice, racism and diversity in our society - especially within the healthcare system. The world at large needs change; a shift away from old school systemic injustices steeped in Western tradition, to developing better, more inclusive approaches. There is no world in which any Canadian should face health disparities due to a flawed system.
Read more about current efforts: